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How Community Health Workers contribute to the SDGs

14 March 2017
The 1st International Symposium on Community Health Workers (CHWs) was held in Kampala, Uganda on 21-23 February 2017 with the theme Contribution of Community Health Workers in attainment of the Sustainable Development Goals.

The symposium was organised by the Makerere University School of Public Health Sciences and Nottingham Trent University and there were over 450 participants from more than 20 countries. With 140 oral and poster presentations, three keynote addresses, 13 panels and two workshops, it was a veritable platform for discussions on a broad spectrum of concern regarding the work of Community Health Workers in pursuit of the goal of universal health care.

PSI participated actively in the symposium, delivering a presentation titled Towards Realising the Human Right to Health: Community Health Workers, and Health Employment in the SDGs Era.

Putting the evolution of CHWs in perspective from the training of Chinese village farmers, who later became known as “barefoot doctors” in the 1930s, to the current situation where full-time CHWs are considered as “volunteers” in many countries, the PSI Health and Social Services Officer, Baba Aye showed that the paradigm shift to a neoliberal model of development had adverse effects on primary health care in general and particularly the conditions of CHWs.  

The momentum generated around the Primary Health Care movement stirred by the 1978 Declaration of Alma Atta was stifled in the 1980s with privatisation, liberalisation and cuts in public funding of health care. There is, however, renewed commitment to bolstering the role of CHWs for the realisation of universal health care, with the SDGs and more recently, the Five-Year Implementation Plan for Health Employment and Economic Growth. CHWs serve as important bridges between rural and peri-urban communities and the health systems in many developing countries.

Most participants shared this view. After rounds of discussions, they adopted the Kampala Statement, which noted that “Community Health Worker programmes can be a huge driving force to attain at least seven SDGs, namely SDGs 1 (ending poverty), 2 (ending hunger and ensuring food security), 3 (health and wellbeing), 5 (gender equality), 6 (clean water and sanitation), 10 (reduce inequalities), and 17 (partnerships for global health).”

Integration of Community Health Workers into the formal health system structure is crucial, while tailoring CHW programmes “to meet needs and priorities that are culturally and contextually appropriate.” Although it was generally agreed that CHWs should be supported with incentives provided, the statement is not clear on remuneration of CHWs who work full-time but are formally “volunteers.”

Ensuring health for all would be a mirage outside social justice and decent work for workers who provide health services. Where CHWs work normal working hours, they should earn decent wages. This was the norm in virtually all CHW programmes before the 1980s, and with a significant number of ongoing CHW programmes across the world. The absence of regular and predictable remuneration, sufficient to meet such full-time CHW needs, jeopardises their ability to ensure their full commitment.  

The symposium will be a biennial event. Decent work and the social protection of CHWs will continue to be a source of concern, which PSI will advance at this forum as an important, integral element of the quest for universal health care. Discussions with a broad array of researchers and practitioners, including members of PSI affiliates, will continue on the Health Information for All (HIFA) and CHW Central platforms.

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